Basic Information
| Provider Information | |||||||||
| NPI: | 1417570029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VRF EYE SPECIALTY GROUP, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22510 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392252510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016852200 | ||||||||
| FaxNumber: | 9012555631 | ||||||||
| Practice Location | |||||||||
| Address1: | 5800 DELTA VIEW RD | ||||||||
| Address2: | |||||||||
| City: | WALLS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386808341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623633888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2020 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9016852200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 152W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.